Few would dispute that curbing rising rates of obesity is one of the greatest public health challenges of the 21st Century, yet as a nation, we grapple with how to talk about being fat. The Centers for Disease Control and Prevention even dances around the subject by labeling overweight kids "at risk for overweight" and obese kids "overweight."
One might argue that labeling any kids or adults is wrong, but you can’t solve the problem unless you name it and quantify it. Well, we’ve quantified it. Roughly one-third of adults are obese and two-thirds are overweight.
So now, we have to do something about this grossly expensive epidemic. Some employers facing ballooning health costs have taken punitive approaches to push their workers to lose weight. But arms flew up aghast when Chicago’s police chief dared to say that all officers must pass a physical fitness test. The police department already has a voluntary program that provides a $250 bonus to the cops that pass. Voluntary, clearly didn’t work
Some obesity experts say these punitive approaches to reduce obesity won’t work, and in fact, they are discriminating. Some have coined this "weightism."
Researchers at Yale University published a paper last month in the International Journal of Obesity saying discrimination based on weight is as much of a problem in American society as discrimination based on race or gender, especially for women and individuals with a Body Mass Index of 35 or higher (a 200 pound 5’4" person has a BMI of 35).
Many contributing factors to obesity are beyond individual control and simply suggesting that people exercise more and eat less probably won’t work, especially if you live in a neighborhood without safe streets and parks and no healthy food. But some behaviors are within our control, and progress cannot be made if political correctness overtakes frank discussions.
I asked one of the Yale study’s lead authors, Rebecca Puhl, about the study, discrimination and possible solutions to the obesity epidemic. Here are her answers:
The study was based on data from 1995-1996. The number of overweight and obese people has grown substantially since then. Thus, would you expect your conclusions of the percent of people who experience discrimination based on their weight to be greater?
We actually controlled for increasing obesity rates in our statistical analysis, so we can confidently conclude that the findings do not reflect increases in obesity, but rather reflect increases in reported experiences of weight discrimination.
Isn’t discrimination based on weight fundamentally different discrimination based on sex, race or disability? Why do you or don’t you agree?
Because people often assume that body weight is "a choice", they feel that it shouldn’t be considered a legitimate form of stigma or discrimination. This is wrong. The causes of obesity are very complex, and to assume that obesity is a choice significantly oversimplies the notion that significant weight loss can be sustained over time. Only a small percentage of people can reach this goal. A large body of science using randomized clinical control trials show poor long-term results in the ability to sustain significant weight loss over time – even with intensive and expensive treatment options. This had led to a greater appreciation of the role that biology plays in regulating body weight, and in the difficulty of sustaining weight loss over time. So, we need to challenge the common assumption that body weight is simply an issue of willpower, and consider the science about the causes and treatment of obesity. I think we also need to question whether a person needs to justify a genetic or biological predisposition for their obesity in order to receive the basic human right of equality. The answer to that is no.
Do you believe discriminating against obese people is wrong? Why? The World Health Organization currently will not hire people who smoke. What if they said they would not hire people with a BMI of 30 (5’4" woman who weights 180 pounds)? Is this the same or different?
Discriminating against an individual because of his or her weight is certainly wrong. It is also important to recognize that BMI is not necessarily an automatic or accurate indicator of health. There are many individuals who are not overweight who are very unhealthy (who, for example, may have high blood pressure or cholesterol), and similarly there are people who are overweight who are in good health and whose blood pressure and cholesterol are in the normal range.
Currently, many large employers are experimenting with wellness programs to help their employees adopt healthy behaviors and thereby reduce health costs. Obese and overweight people and smokers are the primary target of such plans. Is this discrimination?
Rather than imposing penalties on individuals who have a certain BMI or who smoke, which can become discriminatory, a better way for companies to address increasing costs associated with obesity or smoking is to initiate and support social changes that can help change the conditions that create obesity in the first place (such as increasing access of affordable healthy foods, providing opportunities for physical activity, and promoting healthy work environments where it is easy for employees to be healthy.Wellness programs that reward people for making healthy lifestyle changes through improved eating habits or physical activity is much more appropriate and doesn’t discriminate people based on weight. Poor diet and physical inactivity are hurting everybody ñ not just those who are overweight. So incentive programs that reward healthy behaviors offer a much broader umbrella under which people can be supported to become healthier, regardless of their body weight.
While significant contributing factors to obesity, such as environment and genetics, are not behavioral. Many other factors are, thus changing behaviors and social norms is a must to curb rates of obesity. Given the difficulty in changing behaviors but the incredible expense associated with obesity, what solutions do you propose to curb obesity rates that do not "discriminate" against this population?
Currently, our culture is taking a "personal responsibility" approach to try to reduce obesity. We have a billion dollar diet industry that is based on this premise, and thousands of diet books, pills, and plans. But obesity rates continue to rise, and this approach is clearly not working. We need to make major changes in our environment to make it easier for people to be healthy.(As I mentioned above, this can include increasing access and advertising of affordable healthy foods, providing opportunities for physical activity, and promoting healthy work environments where it is easy for employees to be healthy.)